Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1739-43. doi: 10.2215/CJN.00490111. Epub 2011 Jun 3.
There are a limited number of publications on the features of arteriovenous graft infection in hemodialysis patients. The authors compared the clinical presentation, complications, and outcomes of infections of thigh and upper extremity grafts.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The authors queried a prospective access database at a large university medical center and identified 132 patients with graft infections (40 in the thigh and 92 in the upper extremity) requiring surgical excision. The authors collected information regarding the microbiology, complications, and clinical outcomes.
The two graft groups were similar in age, gender, race, and frequency of diabetes. The median age of infected grafts was 162 days for thigh grafts versus 168 days for upper extremity grafts (P = 0.35). Thigh graft infections were more likely than upper extremity graft infections to be caused by a Gram-negative rod (31% versus 4%; P = 0.003), and more likely to result in a metastatic infection (15% versus 3%; P = 0.02). The duration of hospitalization associated with graft infection was similar (10.8 ± 5.4 versus 8.7 ± 6.3 days; P = 0.09). Finally, median catheter dependence was longer after thigh graft than upper arm graft infections (319 versus 237 days; P = 0.04).
As compared with upper extremity graft infections, thigh graft infections requiring excision are more likely to be caused by Gram-negative bacteria and to result in serious metastatic complications. These differences may require different empiric antibiotics and a higher index of suspicion for infection in hemodialysis patients with thigh grafts.
关于血液透析患者动静脉移植物感染的特征，仅有少数出版物对此进行了报道。作者比较了大腿和上肢移植物感染的临床表现、并发症和结局。
设计、设置、参与者和测量方法：作者查询了一家大型大学医学中心的前瞻性血管通路数据库，并确定了 132 例需要手术切除的移植物感染患者（大腿 40 例，上肢 92 例）。作者收集了有关微生物学、并发症和临床结局的信息。
两组移植物患者在年龄、性别、种族和糖尿病发病率方面相似。大腿移植物感染的中位年龄为 162 天，上肢移植物感染的中位年龄为 168 天（P = 0.35）。与上肢移植物感染相比，大腿移植物感染更可能由革兰氏阴性杆菌引起（31%对 4%；P = 0.003），更可能导致转移性感染（15%对 3%；P = 0.02）。与移植物感染相关的住院时间相似（10.8 ± 5.4 天对 8.7 ± 6.3 天；P = 0.09）。最后，大腿移植物感染后导管依赖时间中位数长于上肢臂移植物感染（319 天对 237 天；P = 0.04）。
与上肢移植物感染相比，需要切除的大腿移植物感染更可能由革兰氏阴性菌引起，并导致严重的转移性并发症。这些差异可能需要不同的经验性抗生素，以及对大腿移植物血液透析患者的感染保持更高的警惕性。
